Critical thinking in OB ... HELP!! Jaundice newborn

[Student2001]

I`m trying to figure out a critical thinking exercise and i`m not sure if i have this right..

identified problem is: newborn shows signs of jaundice. TcB currently 13.8.

Nursing interventions: Keep the baby well hydrated with breast milk or formula. Frequent feedings (up to 12 times a day) encourage frequent bowel movements, which help remove bilirubin through the stools. (this is the theory behind this)

outcome: Baby has at least 8 diaper changes a day, and this is helping to get rid of bilirubin, which theoretically is helping to get rid of this condition.

There are some more nursing interventions that i`ll make up.. but am I on the right track??

[anonymousstudent]

There is no way you're going to get 8 poopy diapers out of a newborn.

How else can you encourage the body to remove bilirubin? Think about light...

[ARnursingstudent]

What anon said, exposure to daylight can help, even through a window. Of course, not so long they burn, etc.

[ashleyisawesome, BSN, RN]

how may i ask are you going to encourage this newborn to poop more? agreed with pp think about light.. a certain kind of artificial light?

[NicuGal, MSN, RN]

First you have to determine if baby is at light level, you just don't start jaundiced babies under lights. Look at the rate of rise (age and hours old). This should be in your textbook. Also, is there a cause for the jaundice, not just regular newborn jaundice? How old is baby? Is there a set up for ABO or Rh?

Frequent feedings usually lead to lots of poopy diapers, esp if breastfeeding.

How often do you want to check bili levels? What about parent education? If baby is at light level, you need to address safety issues, such as eye protection, temp, feedings, skin.

[PedsHopeful]

If it helps, my son was born and had very bad jaundice. In addition to extra feedings, they had him wear a billi-blanket every time he went to sleep. The light was suppose to help him break down the bilirubin but in the end he ended up in the hospital for a few days because the billi-blanket wasnt generating enough UV light to help him break it down. The lights in the hospital were much better and they had him in a incubator roasting under those lights for a couple days. After that, he was fine. Agree with he previous ladies, never forget light with jaundice.

[NicuGal, MSN, RN]

Bili blankets work great, but it sounds like they didn't tell you to use it properly. The baby should be on it all the time pretty much, you can bundle it with them, even for feeds, not just sleep. If it is the uninterrupted time with the light that helps bring the level down.

Like I said though, not all jaundiced babies get lit up :)